Laparoscopic colonic surgery: early experience

ABSTRACT

The paper reports early experience with laparoscopic colonic surgery in relation to indications, tumour size, operative time, duration of analgesic requirement postopera-tively, return of bowel activity, postoperative complications and mortality. A multicentre case series study at Jinnah Postgraduate Medical Centre, Orthopedic and Medial Institute, SIUT and South City Hospital between February 2007 and February 2010. Clinical and operative records of all laparoscopic-assisted colonic procedures performed between February 2007 and February 2010 were studied. 80 laparoscopic-assisted colonic surgeries were performed during this period. There were 74 cases of carcinoma, 5 cases of tuberculosis and 1 case of polyp. Laparoscopic-assisted procedures included right hemicolectomy in 54 cases, left hemicolectomy in 15 cases, sigmoid colectomy in 6 cases, segmental resection of splenic flexure in 2 cases, transverse colostomy in 3 cases. Eight cases were converted to open surgery; six because of locally advanced disease, one because of bleeding and one because of failure to localize the tumour. Mean operative time was 150 minutes. The mean tumour size was 6cm. Mean duration for analgesic requirement was 2.5 days. Mean time to return of bowel activity was 2.7 days with a mean hospital stay of 5 days. Intraoperative traction injury to the small bowel was encountered in 1 patient. Postoperatively 2 patients had local wound infection and 2 patients developed pulmonary infection. Laparoscopic-assisted colonic procedures are associated with a smaller wound, quicker return of bowel activity, reduced consumption of analgesics, a shorter hospital stay and low rates of pulmonary infection. Laparoscopic colonic surgery is feasible and a logical progression towards acquisition of advanced laparoscopic skills with good results: